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Patient safety alert – risk of distress and death from inappropriate doses of naloxone in patients on long-term opioid or opiate treatment

A patient safety alert has been issued by NHS England to further raise awareness of the risk of harm or death from inappropriate doses of naloxone in patients on long-term opioid or opiate treatment, where these drugs are used to provide relief from both chronic and acute pain, such as following surgery.

In cases where opioid or opiate treatments have caused depression of the central nervous system (semi-consciousness or unconsciousness), particularly when respiratory depression occurs (dangerously shallow or slow breathing), naloxone can be used as a rapid treatment to completely or partially reverse the effect of the opioid or opiate.

As well as being used for patients whose opioids or opiates were medically prescribed, naloxone also has a role in treating people who are taking illicit opioids or opiates and have overdosed or become intoxicated on these drugs.

The use of inappropriate doses of naloxone can cause a rapid reversal of the physiological effects of long-term opioids or opiates used for pain control, leading to intense pain and distress, and acute withdrawal syndrome. This can lead to hypertension, cardiac arrhythmias, pulmonary oedema and cardiac arrest.